Dear Glenn,
I have a paediatric patient @ 10 years who has had anaphylaxis to quorn in a vegetarian meal.
Has positive skin prick test to pure quorn supplied by manufacturer. Negative to other food allergens and inhaled molds.
Quorn is a mycoprotein. Is grown in culture.
Only few case reports of allergic reactions. The first reference is NOT a case report, but a letter summarising anecdotal reactions from a lobby group in USA. I am aware of one Aust colleague who thinks they have a patient with adult FPIES from the product.
I do not have facilities to do in vitro work but wondered if there were those in the lab or clinical list who might be interested in doing so using pure product and patient serum (which I can probably get).
Ray--
Dr Raymond J. Mullins
Suite 1, John James Medical Centre, 175 Strickland Crescent, Deakin ACT 2600
Tel 02-6282 2689; Fax 02-6282 2526; email rmullins@allergycapital.com.au
INFO ON QUORN:
http://www.quorn.com.au/The-Quorn-Story/
http://en.wikipedia.org/wiki/Quorn
CASE REPORTS1. Allergy. 2003 May;58(5):455-6.
Adverse reactions linked to Quorn-brand foods.
Jacobson MF.
Center for Science in the Public Interest, 1875 Connecticut Ave. NW Suite 300,
Washington, DC, USA. mjacobson@cspinet.org
2. J Clin Pathol. 2002 Nov;55(11):876-7.
Sensitivity to Quorn mycoprotein (Fusarium venenatum) in a mould allergic
patient.
Katona SJ, Kaminski ER.
3. Clin Exp Allergy. 1993 Apr;23(4):257-60.
Investigation of possible adverse allergic reactions to mycoprotein ('Quorn').
Tee RD, Gordon DJ, Welch JA, Newman Taylor AJ.
Department of Occupational and Environmental Medicine, National Heart and Lung
Institute, Royal Brompton Hospital, London.
Mycoprotein ('Quorn') is a food produced for human consumption from Fusarium
graminearum. Crossreactivity studies showed that mycoprotein shared multiple
common allergenic determinants with Aspergillus fumigatus and Cladosporium
herbarum and some with Alternaria alternata. There is, therefore, a potential for
mould allergic patients to react adversely to inhaled or ingested mycoprotein.
Mycoprotein RAST screening of mycoprotein production workers was made during a 2
year period. Two of the production workers had specific RAST binding > or = 2%
but none reported symptoms. Two of 10 patients referred to hospital following
vomiting and diarrhoea after ingestion of mycoprotein had a mycoprotein
skin-prick test weal > or = 2 mm but none had a significantly raised RAST. These
largely negative results are important and reassuring because consumption of the
product in the U.K. is now widespread and increasing.
4. J Allergy Clin Immunol. 2003 May;111(5):1106-10.
Immediate-type hypersensitivity reaction to ingestion of mycoprotein (Quorn) in a
patient allergic to molds caused by acidic ribosomal protein P2.
Hoff M, Trüeb RM, Ballmer-Weber BK, Vieths S, Wuethrich B.
Department of Allergology, Paul-Ehrlich-Institut, Langen, Germany.
BACKGROUND: Quorn is the brand name for a line of foods made with so-called
"mycoprotein," which springs from the mold Fusarium venenatum. Since the
introduction on the food market, there have been complaints from consumers
reporting adverse gastrointestinal reactions after ingestion of mycoprotein. To
date, it is not clear whether the reported symptoms are IgE-mediated.
OBJECTIVE: The aim of the study was to describe for the first time a case history
of an asthmatic patient with severe hypersensitivity reactions to ingested
mycoprotein and to identify and characterize the potential allergen that might be
responsible for this.
METHODS: The sensitization pattern of the asthmatic subject was characterized,
and food allergy to mycoprotein was assessed by double-blinded placebo-controlled
food challenge. Afterward, specific IgE antibodies of the serum of this patient
were used to screen a Fusarium culmorum cDNA expression library. The coding
sequence of one enriched cDNA-clone was expressed in Escherichia coli to produce
a recombinant protein that was further purified and immunologically
characterized.
RESULTS: The patient showed high sensitization to many known aeroallergens but
apart from Quorn not to any other tested food samples. The deduced amino acid
sequence of the enriched cDNA-clone (Fus c 1) showed large identity to the 60S
acidic ribosomal protein P2 which is highly conserved among several species and
also described as minor allergen in other mold species. The frequency of IgE
reactivity of sera from F culmorum -sensitized subjects to rFus c 1 was
approximately 35%. By enzyme allergosorbent test inhibition, we found 65%
inhibition of mycoprotein IgE reactivity by rFus c 1. On the opposite we found
reduced IgE reactivity of rFus c 1 of 68% by using mycoprotein as inhibitor.
CONCLUSIONS: Sensitization to mold allergens by the respiratory tract and
subsequent oral ingestion of cross-reactive proteins may lead to severe
food-allergic reactions. Thus, the 60S acidic ribosomal protein P2 of F venenatum
probably is the reason for the described severe hypersensitivity reactions of the
patient to Quorn-mycoprotein because of its potential cross-reactivity to the F
culmorum allergen Fus c 1.
I have a paediatric patient @ 10 years who has had anaphylaxis to quorn in a vegetarian meal.
Has positive skin prick test to pure quorn supplied by manufacturer. Negative to other food allergens and inhaled molds.
Quorn is a mycoprotein. Is grown in culture.
Only few case reports of allergic reactions. The first reference is NOT a case report, but a letter summarising anecdotal reactions from a lobby group in USA. I am aware of one Aust colleague who thinks they have a patient with adult FPIES from the product.
I do not have facilities to do in vitro work but wondered if there were those in the lab or clinical list who might be interested in doing so using pure product and patient serum (which I can probably get).
Ray--
Dr Raymond J. Mullins
Suite 1, John James Medical Centre, 175 Strickland Crescent, Deakin ACT 2600
Tel 02-6282 2689; Fax 02-6282 2526; email rmullins@allergycapital.com.au
INFO ON QUORN:
http://www.quorn.com.au/The-Quorn-Story/
http://en.wikipedia.org/wiki/Quorn
CASE REPORTS1. Allergy. 2003 May;58(5):455-6.
Adverse reactions linked to Quorn-brand foods.
Jacobson MF.
Center for Science in the Public Interest, 1875 Connecticut Ave. NW Suite 300,
Washington, DC, USA. mjacobson@cspinet.org
2. J Clin Pathol. 2002 Nov;55(11):876-7.
Sensitivity to Quorn mycoprotein (Fusarium venenatum) in a mould allergic
patient.
Katona SJ, Kaminski ER.
3. Clin Exp Allergy. 1993 Apr;23(4):257-60.
Investigation of possible adverse allergic reactions to mycoprotein ('Quorn').
Tee RD, Gordon DJ, Welch JA, Newman Taylor AJ.
Department of Occupational and Environmental Medicine, National Heart and Lung
Institute, Royal Brompton Hospital, London.
Mycoprotein ('Quorn') is a food produced for human consumption from Fusarium
graminearum. Crossreactivity studies showed that mycoprotein shared multiple
common allergenic determinants with Aspergillus fumigatus and Cladosporium
herbarum and some with Alternaria alternata. There is, therefore, a potential for
mould allergic patients to react adversely to inhaled or ingested mycoprotein.
Mycoprotein RAST screening of mycoprotein production workers was made during a 2
year period. Two of the production workers had specific RAST binding > or = 2%
but none reported symptoms. Two of 10 patients referred to hospital following
vomiting and diarrhoea after ingestion of mycoprotein had a mycoprotein
skin-prick test weal > or = 2 mm but none had a significantly raised RAST. These
largely negative results are important and reassuring because consumption of the
product in the U.K. is now widespread and increasing.
4. J Allergy Clin Immunol. 2003 May;111(5):1106-10.
Immediate-type hypersensitivity reaction to ingestion of mycoprotein (Quorn) in a
patient allergic to molds caused by acidic ribosomal protein P2.
Hoff M, Trüeb RM, Ballmer-Weber BK, Vieths S, Wuethrich B.
Department of Allergology, Paul-Ehrlich-Institut, Langen, Germany.
BACKGROUND: Quorn is the brand name for a line of foods made with so-called
"mycoprotein," which springs from the mold Fusarium venenatum. Since the
introduction on the food market, there have been complaints from consumers
reporting adverse gastrointestinal reactions after ingestion of mycoprotein. To
date, it is not clear whether the reported symptoms are IgE-mediated.
OBJECTIVE: The aim of the study was to describe for the first time a case history
of an asthmatic patient with severe hypersensitivity reactions to ingested
mycoprotein and to identify and characterize the potential allergen that might be
responsible for this.
METHODS: The sensitization pattern of the asthmatic subject was characterized,
and food allergy to mycoprotein was assessed by double-blinded placebo-controlled
food challenge. Afterward, specific IgE antibodies of the serum of this patient
were used to screen a Fusarium culmorum cDNA expression library. The coding
sequence of one enriched cDNA-clone was expressed in Escherichia coli to produce
a recombinant protein that was further purified and immunologically
characterized.
RESULTS: The patient showed high sensitization to many known aeroallergens but
apart from Quorn not to any other tested food samples. The deduced amino acid
sequence of the enriched cDNA-clone (Fus c 1) showed large identity to the 60S
acidic ribosomal protein P2 which is highly conserved among several species and
also described as minor allergen in other mold species. The frequency of IgE
reactivity of sera from F culmorum -sensitized subjects to rFus c 1 was
approximately 35%. By enzyme allergosorbent test inhibition, we found 65%
inhibition of mycoprotein IgE reactivity by rFus c 1. On the opposite we found
reduced IgE reactivity of rFus c 1 of 68% by using mycoprotein as inhibitor.
CONCLUSIONS: Sensitization to mold allergens by the respiratory tract and
subsequent oral ingestion of cross-reactive proteins may lead to severe
food-allergic reactions. Thus, the 60S acidic ribosomal protein P2 of F venenatum
probably is the reason for the described severe hypersensitivity reactions of the
patient to Quorn-mycoprotein because of its potential cross-reactivity to the F
culmorum allergen Fus c 1.
